乳腺非肿块型病变粗针穿刺活检病理学低估的危险因素分析

Risk factors of pathological underestimation in breast non-mass lesions by core needle biopsy

目的探讨乳腺非肿块型病变(NML)超声引导下粗针穿刺活检(US-CNB)病理学低估的危险因素。方法回顾性收集2018年3月至2021年12月永康市第一人民医院239例患者239个病灶行US-CNB的NML的临床资料,包括临床表现、超声特征、穿刺相关参数等,根据US-CNB穿刺病理检查结果与术后病理检查结果,分为低估组28个与未低估组211个,分析US-CNB所致病理学低估的原因。结果239个乳腺NML中,穿刺病理检查结果提示良性病灶84个,高危病灶16个,原位癌64个,浸润癌75个。病灶切除术后,28个病灶出现病理学低估(11.72%,28/239)。单因素分析结果提示,低估组与未低估组在NML局部疼痛、超声类型、微钙化、血流分级、乳腺影像报告数据与系统分类、多点取材、腋窝异常淋巴结分布等差异均有统计学意义(均P<0.05)。多因素分析结果提示,超声Ⅱ型、血流分级高、伴腋窝异常淋巴结均为NML发生US-CNB病理学低估的危险因素(均P<0.05),多点取材为其保护因素(P<0.05)。结论NML行US-CNB存在较高的病理学低估率;超声Ⅱ型、血流分级高、多点取材不足、伴腋窝异常淋巴结是NML出现US-CNB病理学低估的主要因素。

Objective To explore the risk factors of pathological underestimation in breast non-mass lesion(NML)by ultrasound-guided core needle biopsy(US-CNB).Methods A total of 239 patients with breast NML underwent US-CNB in Yongkang First People's Hospital from March 2018 to December 2021.The clinical manifestations,ultrasonic characteristics,puncture related parameters and pathological results of patients were retrospectively analyzed.Comparing the US-CNB pathological results with postoperative pathological results,patients were divided into underestimated group and non-underestimated group.The risk factors of pathological underestimation were analyzed.Results According to US-CNB results,there were 84 cases of benign lesions,16 cased of high-risk lesions,64 cases of carcinoma in situ and 75 cases of invasive carcinoma.The postoperative pathology showed that 28 cases were pathologically underestimated(11.72%).Univariate analysis showed that there were significant differences between the underestimated group and the non-underestimated group in NML local pain,ultrasound type,microcalcification,blood flow grade,grade of breast imaging reporting and data system(BI-RADS),multi-point sampling and axillary abnormal lymph nodes(all P<0.05).Multivariate analysis showed that ultrasound typeⅡ,color flow grade,multi-point sampling,and axillary abnormal lymph nodes were independent risk factors for the underestimation in NML by US-CNB(all P<0.05).Conclusion There is a high pathological underestimation rate in breast non-mass lesions by US-CNB.Ultrasound typeⅡ,high blood grade,insufficient multi-point sampling and axillary abnormal lymph nodes in NML are the main factors influencing the underestimation in NML by US-CNB.